1型阈值前期和阈值期早产儿视网膜病变血小板参数分析

目的　观察不同时间段１型阈值前期和阈值期早产儿视网膜病变（ｒｅｔｉｎｏｐａｔｈｙｏｆｐｒｅｍａｔｕｒｉｔｙ,ＲＯＰ）患儿血小板相关参数的变化,分析其与ＲＯＰ发生发展的内在联系。方法收集我院新生儿病房２０１３年１月至２０１４年１２月诊治的早产儿临床资料,纳入早产儿分为１型阈值前期与阈值期ＲＯＰ组和对照组,对照组出生孕周与ＲＯＰ组匹配,眼底筛查未见明显ＲＯＰ病变,并对两组矫正胎龄为３２～３３周、３６～３７周、４０～４１周、４４～４５周者的血小板平均体积（ｍｅａｎｐｌａｔｅｌｅｔｖｏｌｕｍｅ,ＭＰＶ）和血小板计数（ｐｌａｔｅｌｅｔｃｏｕｎｔｓ,ＰＣ）进行比较。结果　与对照组相比,ＲＯＰ组患儿３６～３７周和４０～４１周的ＭＰＶ［（１０．８６±１．８７）ｆＬ、（１０．１２±１．４５）ｆＬ,（１０．７４±１．６６）ｆＬ、（１０．１７±１．５２）ｆＬ］显著增加（均为Ｐ＜０．０５）;３２～３３周和４４～４５周ＭＰＶ［（１０．１８±１．５４）ｆＬ、（１０．３７±１．９１）ｆＬ,（１０．５６±１．２１）ｆＬ、（１０．４２±０．９７）ｆＬ］差异均无统计学意义（均为Ｐ＞０．０５）。与对照组相比,ＲＯＰ组患儿３２～３３周、３６～３７周、４０～４１周、４４～４５周的ＰＣ［（２８８．００±１４３．２５）×１０９Ｌ－１、（２９１．００±１１３．２７）×１０９Ｌ－１,（２７７．２３±９２．８８）×１０９Ｌ－１、（２６５．４９±１０２．１３）×１０９ Ｌ－１,（３０６．００±１７１．８３）×１０９Ｌ－１、（２８４．００±１４３．５６）×１０９Ｌ－１,（３１１．４３±１３１．２４）×１０９ Ｌ－１、（３０３．６２±９４．５５）×１０９Ｌ－１］差异均无统计学意义（均为Ｐ＞０．０５）。进一步进行多因素Ｌｏｇｉｓｔｉｃ回归分析,结果显示ＭＰＶ与１型阈值前期和阈值期ＲＯＰ发生相关。结论　ＭＰＶ的变化可能与ＲＯＰ的病情严重程度和检查时间的差异相关;ＭＰＶ增高是１型阈值前期和阈值期ＲＯＰ发生的高危因素,活化的血小板在１型阈值前期和阈值期ＲＯＰ的发生发展中发挥重要作用。     

血清可溶性肿瘤坏死因子受体与2型糖尿病视网膜病变相关性研究

目的　研究血清可溶性肿瘤坏死因子受体（ｓｏｌｕｂｌｅｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒｒｅｃｅｐｔｏｒ,ｓＴＮＦＲ）与２型糖尿病视网膜病变的相关性。方法　６６例２型糖尿病患者通过眼底检查和眼底荧光血管造影按照ＥＤＴＲＳ分期分为３组:无糖尿病视网膜病变（ｎｏｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＮＤＲ;ｎ＝２２）组、非增殖型糖尿病视网膜病变（ｎｏｎｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＮＰＤＲ;ｎ＝２４）组和增殖型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ;ｎ＝２０）组。２１名健康人作为对照组。检测４组研究对象血清中肿瘤坏死因子（ｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒ,ＴＮＦ）-α、ｓＴＮＦＲ-１、ｓＴＮＦＲ-２水平。组间统计分析采用非参数Ｍａｎｎ-ＷｈｉｔｎｅｙＵ检验。结果　血清中ＴＮＦ-α中位数分别为:对照组０ｐｇ·ｍＬ－１、ＮＤＲ组３．４５ｐｇ·ｍＬ－１、ＮＰＤＲ组３．９２ｐｇ·ｍＬ－１、ＰＤＲ组８．１２ｐｇ·ｍＬ－１。对照组与ＰＤＲ组（Ｐ＜０．００１）、ＮＤＲ组与ＰＤＲ组（Ｐ＝０．００８）比较差异均有统计学意义。血清中ｓＴＮＦＲ-１水平中位数:对照组１．５０ｎｇ·ｍＬ－１、ＮＤＲ组１．８８ｎｇ·ｍＬ－１、ＮＰＤＲ组２．５８ｎｇ·ｍＬ－１、ＰＤＲ组３．００ｎｇ·ｍＬ－１。对照组与ＮＰＤＲ组（Ｐ＜０．００１）、对照组与ＰＤＲ组（Ｐ＜０．００１）、ＮＤＲ组与ＮＰＤＲ组（Ｐ＝０．００７）、ＮＤＲ组与ＰＤＲ组（Ｐ＜０．００１）比较,差异均有统计学意义。血清中ｓＴ-ＮＦＲ-２中位数分别为:对照组３．８８ｎｇ·ｍＬ－１、ＮＤＲ组５．０１ｎｇ·ｍＬ－１、ＮＰＤＲ组５．２１ｎｇ·ｍＬ－１、ＰＤＲ组６．３３ｎｇ·ｍＬ－１。除了ＮＤＲ组与ＮＰＤＲ组（Ｐ＝０．０７０）间差异无统计学意义外,其他组间差异均有统计学意义（均为Ｐ＜０．０５）。结论　血清中ｓＴＮＦＲ与２型糖尿病视网膜病变密切相关,表明ｓＴＮＦＲ在糖尿病视网膜病变的发生发展中起到了一定的作用。对ｓＴＮＦＲ进行进一步研究可以寻找治疗糖尿病视网膜病变新的靶点。     

趋化素、肿瘤坏死因子-α与2型糖尿病视网膜病变的相关性

目的　探讨２型糖尿病视网膜病变（ｔｙｐｅ２ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,Ｔ２ＤＲ）患者血清中趋化素（ｃｈｅｍｅｒｉｎ）、肿瘤坏死因子-α（ｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒ-α,ＴＮＦ-α）水平及其临床意义。方法　将１６０例研究对象分为增殖性糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａ-ｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）组４０例,非增殖性糖尿病视网膜病变（ｎｏｎ-ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＮＰＤＲ）组４０例,单纯糖尿病（ｄｉａｂｅｔｅｓｍｅｌｌｉｔｕｓ,ＤＭ）组患者４０例以及健康对照（ｎｏｒｍａｌｃｏｎｔｒｏｌｓ,ＮＣ）组４０例。观察４组研究对象的体检指标,并检测空腹胰岛素、血糖、血脂、糖化血红蛋白及血清中ｃｈｅｍｅｒｉｎ、ＴＮＦ-α等含量。计算稳态模型评估的胰岛素抵抗指数（ｉｎｓｕｌｉｎｒｅｓｉｓｔａｎｃｅｉｎ-ｄｅｘ,ＨＯＭＡ-ＩＲ）。结果　ＤＭ组［ｃｈｅｍｅｒｉｎ为（３．８３±０．４６）ｍｇ?Ｌ－１、ＴＮＦ-α为（３７．６９±５．０７）ｎｇ?Ｌ－１］、ＮＰＤＲ组［ｃｈｅｍｅｒｉｎ为（４．６８±０．７４）ｍｇ?Ｌ－１、ＴＮＦ-α为（４０．６９±５．９０）ｎｇ?Ｌ－１］、ＰＤＲ组［ｃｈｅｍｅｒｉｎ为（５．８６±１．２９）ｍｇ?Ｌ－１、ＴＮＦ-α为（４４．１７±６．６３）ｎｇ?Ｌ－１］血清中ｃｈｅｍｅｒｉｎ、ＴＮＦ-α水平均较ＮＣ组［ｃｈｅｍｅｒｉｎ为（２．０１±０．５４）ｍｇ?Ｌ－１、ＴＮＦ-α为（２２．６０±９．７８）ｎｇ?Ｌ－１］升高,且随着ＤＲ病情的进展逐渐升高,差异均有统计学意义（均为Ｐ＜０．０５）。相关分析显示血清中ｃｈｅｍｅｒｉｎ水平与收缩压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、胰岛素抵抗指数均呈正相关（ｒ＝０．３３１、０．３６１、０．２５１、０．３４８、０．３０６、０．５２３、０．６４４,均为Ｐ＜０．０５）;血清中ＴＮＦ-α水平与收缩压、舒张压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、胰岛素抵抗指数均呈正相关（ｒ＝０．２９９、０．１５９、０．６０５、０．２６２、０．４０７、０．２８２、０．６１９、０．８０９,均为Ｐ＜０．０５）;血清中ｃｈｅｍｅｒｉｎ与ＴＮＦ-α水平呈正相关（ｒ＝０．７３８,Ｐ＜０．０５）。结论　血清中ｃｈｅｍｅｒｉｎ和ＴＮＦ-α水平的升高是Ｔ２ＤＲ的危险因子,可能共同参与了Ｔ２ＤＲ的发生发展。     

LY294002联合奥曲肽对bFGF诱导的兔晶状体上皮细胞增殖的影响

目的　探讨ＬＹ２９４００２联合奥曲肽对碱性成纤维细胞生长因子（ｂａｓｉｃｆｉｂｒｏｂｌａｓｔｇｒｏｗｔｈｆａｃｔｏｒ,ｂＦＧＦ）诱导的兔晶状体上皮细胞（ｌｅｎｓｅｐｉｔｈｅｌｉａｌｃｅｌｌｓ,ＬＥＣｓ）增殖的影响。方法　兔眼ＬＥＣｓ经原代和传代培养后,共分为４组:空白对照组、增殖对照组、实验药物组、增殖药物组。空白对照组使用仅含无血清ＤＭＥＭ培养;增殖对照组使用加ｂＦＧＦ（１０ｍｇ·Ｌ－１）的无血清ＤＭＥＭ;实验药物组培养时在不加ｂＦＧＦ增殖的情况下分别单独应用１０－５ｍｏｌ·Ｌ－１ＬＹ２９４００２、单独应用１０－９ｍｏｌ·Ｌ－１奥曲肽和联合应用１０－５ｍｏｌ·Ｌ－１ＬＹ２９４００２与１０－９ｍｏｌ·Ｌ－１奥曲肽来培养;增殖药物组在加ｂＦＧＦ增殖的情况下分别单独应用１０－５ｍｏｌ·Ｌ－１ＬＹ２９４００２、单独应用１０－９ｍｏｌ·Ｌ－１奥曲肽和联合应用１０－５ｍｏｌ·Ｌ－１ＬＹ２９４００２和１０－９ｍｏｌ·Ｌ－１奥曲肽进行细胞培养,每组重复５次。各组分别培养４８ｈ。ＭＴＴ比色法测定吸光度（Ａ值）分析各组细胞的生长抑制率,流式细胞仪检测各周期细胞的百分率。结果　增殖对照组与空白对照组相比,吸光度Ａ值升高（Ｐ＜０．０５）;实验药物组中各组分别与空白对照组相比,吸光度Ａ值均有不同程度下降（均为Ｐ＜０．０５）;增殖药物组中各组分别与增殖对照组相比,吸光度Ａ值明显下降（均为Ｐ＜０．０５）;生长抑制率与吸光度Ａ值趋势相同。经流式细胞仪分析,实验药物组中联合用药组与两个单独用药组相比Ｇ０／Ｇ１期细胞比例增高,Ｓ期细胞比例降低（均为Ｐ＜０．０５）;增殖药物组中,联合用药组与两个单独用药组相比也出现Ｇ０／Ｇ１期细胞比例增高,Ｓ期细胞比例降低（均为Ｐ＜０．０５）。结论　ＬＹ２９４００２联合奥曲肽较单独用药对ＬＥＣｓ的增殖抑制作用更强。这为临床筛选药物防治后发性白内障提供依据。     

原发性视网膜色素变性患者体内血液组分的异常变化特点

目的　了解原发性视网膜色素变性（ｒｅｔｉｎｉｔｉｓｐｉｇｍｅｎｔｏｓａ,ＲＰ）患者体内各血液组分的变化情况,为探寻其发病机理和防治提供参考。方法　采用回顾性序列病例研究方法,纳入临床确诊为原发性ＲＰ患者１１９例,正常人对照组１５０例,按盲法由专业技术人员完成血液样本的血常规检查,并分别行ＲＰ组和正常组比较。结果　在ＲＰ患者体内,单核细胞、中性粒细胞、嗜碱性粒细胞百分比分别为（６．５４±１．９４）％、（５５．８９±９．０２％）％、（０．３０±０．４０）％,单核细胞计数、血红蛋白、平均红细胞体积、平均血红蛋白量、红细胞体积分布宽度、平均血小板宽度分别为（０．４２±０．１６）×１０９Ｌ－１、（１４４．２９±１６．４６）ｇ?Ｌ－１、（８８．２３±５．２１）ｆＬ、（３０．３０±２．００）ｐｇ、（１２．８０±０．８０）％、（１２．５±４．９）ｆＬ,均较正常组明显降低（均为Ｐ＜０．０５）;淋巴细胞百分比、淋巴细胞计数、嗜酸性粒细胞计数、嗜碱性粒细胞计数、红细胞计数、血小板计数、平均血小板体积、血小板比积分别为（３４．０９±８．１８）％、（２．２０±０．６１）×１０９Ｌ－１、（０．１０±０．０９）×１０９ Ｌ－１、（０．０１±０．０２）×１０９ Ｌ－１、（４．８２±０．４６）×１０１２Ｌ－１、（２２８．２０±５１．１３）×１０９Ｌ－１、（１０．３０±１．２６）ｆＬ、０．２３±０．０５,均较正常组明显升高（均为Ｐ＜０．０５）。余下的参数与对照组相比,差异均无统计学意义（均为Ｐ＞０．０５）。结论　ＲＰ患者体内血液各组分存在异常变化,提示其发病机理可能与血液成分动态变化有关。     

白藜芦醇对青光眼视网膜氧化损伤的保护作用

目的　探讨白藜芦醇对青光眼视网膜氧化损伤的保护作用。方法　３０只健康雄性成年家兔随机分为对照组、模型组和白藜芦醇治疗组,每组１０只。模型组和白藜芦醇治疗组用２５ｇ?Ｌ－１羟丙基甲基纤维素溶液０．２ｍＬ注入家兔前房内,制作青光眼模型。白藜芦醇治疗组按每日３００ｍｇ?ｋｇ－１体质量给予白藜芦醇灌胃,对照组和模型组给予等体积生理盐水灌胃。给药２８ｄ后测定视网膜抗氧化酶超氧化物歧化酶（ｓｕｐｅｒｏｘｉｄｅｄｉｓｍｕｔａｓｅ,ＳＯＤ）、谷胱甘肽过氧化物酶（ｇｌｕｔａｔｈｉｏｎｅｐｅｒｏｘｉｄａｓｅ,ＧＰＸ）和过氧化氢酶（ｃａｔａｌａｓｅ,ＣＡＴ）的活性,抗氧化物质还原型谷胱甘肽（ｇｌｕｔａｔｈｉｏｎｅ,ＧＳＨ）和还原型抗坏血酸（ａｓｃｏｒｂｉｃａｃｉｄ,ＡｓＡ）含量及一氧化氮（ｎｉｔｒｉｃｏｘｉｄｅ,ＮＯ）和丙二醛（ｍｅｔｈａｎｅｄｉｃａｒｂｏｘｙｌｉｃａｌｄｅｈｙｄｅ,ＭＤＡ）的含量。结果　模型组视网膜抗氧化酶ＳＯＤ、ＧＰＸ、ＣＡＴ活性及抗氧化物质ＧＳＨ、ＡｓＡ含量分别为（４２．０±３．３）Ｕ?ｍｇ－１、（１８．３±１．７）Ｕ?ｍｇ－１、（１．９±０．２）Ｕ?ｍｇ－１、（３３．３±２．７）ｍｇ?ｍｇ－１和（９７．０±７．６）ｍｇ?ｍｇ－１,均低于对照组（均为Ｐ＜０．０５）;ＮＯ和ＭＤＡ含量分别为（３７．０±２．９）μｍｏｌ?ｍｇ－１和（１８．０±１．７）μｍｏｌ?ｍｇ－１,均高于对照组（均为Ｐ＜０．０５）。白藜芦醇治疗组视网膜上述抗氧化酶活性、ＧＳＨ和ＡｓＡ含量分别为（４９．２±２．９）Ｕ?ｍｇ－１、（２４．１±３．２）Ｕ?ｍｇ－１、（２．８±０．２）Ｕ?ｍｇ－１、（４３．０±３．５）ｍｇ?ｍｇ－１和（１０８．４±８．１）ｍｇ?ｍｇ－１,均高于模型组,但低于对照组（均为Ｐ＜０．０５）;ＮＯ和ＭＤＡ含量分别为（３０．１±２．４）μｍｏｌ?ｍｇ－１和（１２．４±１．０）μｍｏｌ?ｍｇ－１,低于模型组,但高于对照组（均为Ｐ＜０．０５）。结论　白藜芦醇能够增加视网膜抗氧化酶活性和抗氧化物质ＧＳＨ和ＡｓＡ含量,从而可以减青光眼视网膜的氧化应激损伤。     

同型半胱氨酸和视黄醇结合蛋白4与糖尿病视网膜病变的相关性研究

目的　检测并分析同型半胱氨酸（ｈｏｍｏｃｙｓｔｅｉｎｅ,Ｈｃｙ）及视黄醇结合蛋白４（ｒｅｔｉ-ｎｏｌｂｉｎｄｉｎｇｐｒｏｔｅｉｎ４,ＲＢＰ４）与糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＤＲ）的关系,以探讨对特定人群ＤＲ的诊断方法。方法　选取２０１４年６月到２０１５年６月桂林医学院附属医院内分泌科就诊的２型糖尿病患者２００例,所有患者进行眼底检查必要时行眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）,根据眼底情况分为增殖期糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）组、非增殖期糖尿病视网膜病变（ｎｏｎ-ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉ-ａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＮＰＤＲ）组,以及非糖尿病视网膜病变（ｎｏｎ-ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＮＤＲ）组;检测各组空腹血糖（ｆａｓｔｉｎｇｐｏｓｔｐｒａｎｄｉａｌｇｌｕｃｏｓｅ,ＦＰＧ）、餐后２ｈ血糖（２-ｈｏｕｒｐｏｓｔｐｒａｎｄｉａｌｇｌｕｃｏｓｅ,２ｈＰＧ）、糖化血红蛋白（ｇｌｙｃｏｓｙｌａｔｅｄｈｅｍｏｇｌｏｂｉｎ,ＨｂＡ１ｃ）、血脂、Ｈｃｙ、ＲＢＰ４水平。结果　ＰＤＲ组的Ｈｃｙ（１７．６０±４．４７）μｍｏｌ·Ｌ－１、ＲＢＰ４（１６．３２±３．５７）μｇ·ｍＬ－１及ＮＰＤＲ组的Ｈｃｙ（１３．０１±２．８０）μｍｏｌ·Ｌ－１、ＲＢＰ４（１２．２５±２．４５）μｇ·ｍＬ－１水平明显高于ＮＤＲ组的Ｈｃｙ（６．９９±２．３３）μｍｏｌ·Ｌ－１、ＲＢＰ４（８．８９±１．９０）μｇ·ｍＬ－１,且随着ＤＲ病情的进展逐渐升高,差异均有统计学意义（均为Ｐ＜０．０５）;ＰＤＲ组病程、２ｈＰＧ、ＨｂＡ１ｃ、ＴＧ、ＬＤＬ-Ｃ、Ｈｃｙ、ＲＢＰ４水平明显高于ＮＰＤＲ组、ＮＤＲ组（均为Ｐ＜０．０５）。相关分析显示,２型糖尿病患者的ＲＢＰ４与病程、年龄、ＨｂＡ１ｃ、ＦＰＧ、２ｈＰＧ、ＴＣ、ＴＧ、ＬＤＬ-Ｃ、Ｈｃｙ呈显著正相关,与ＨＤＬ-Ｃ呈负相关。对ＤＲ的危险因素进行多元回归分析结果显示,病程、ＨｂＡ１ｃ、ＲＢＰ４、Ｈｃｙ是影响ＤＲ的主要危险因素。结论　测定Ｈｃｙ及ＲＢＰ４可及早发现ＤＲ,为早期筛查及治疗提供一定的方向。     

白内障超声乳化联合玻璃体切割术治疗增生性糖尿病视网膜病变

目的　探讨白内障超声乳化联合玻璃体切割术治疗增生性糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）的疗效。方法　选取２００９年１０月至２０１４年５月在我科住院并行白内障超声乳化联合玻璃体切割术的ＰＤＲ患者５６例（７５眼）,术后随访６～６０（２８．２４±５．４７）个月。观察术后最佳矫正视力、眼压及并发症等情况。结果　全部患者手术均顺利完成,术后视力提高者７０眼（９３．３３％）,视力不变者３眼（４．００％）,视力下降者２眼（２．６７％）。术后１个月、３个月及末次随访时眼压分别为（２０．３±９．２）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、（１７．１±７．３）ｍｍＨｇ、（１９．２±８．５）ｍｍＨｇ,与术前的（１２．７±６．１）ｍｍＨｇ相比,差异均有统计学意义（均为Ｐ＜０．０５）。术后主要并发症包括后囊膜混浊８眼,角膜轻度水肿５眼,前房渗出５眼,玻璃体再出血２眼,视网膜脱离２眼,新生血管性青光眼２眼。结论　白内障超声乳化联合玻璃体切割术治疗ＰＤＲ安全有效,术后视力提高较明显,并发症发生率较低,值得在临床工作中推广应用。     

豚鼠眼球正视化过程中T-PA在脉络膜中表达的变化

目的　研究豚鼠正视化过程中组织纤溶酶原激活物（ｔｉｓｓｕｅｐｌａｓｍｉｎｏｇｅｎａｃｔｉｖａｔｏｒ, Ｔ-ＰＡ）在脉络膜上表达的变化规律。方法　选取３周龄健康三色豚鼠４０只,随机分为４组,分别于３周龄、５周龄、７周龄、９周龄处死,并分离脉络膜,入组前与处死前进行屈光度及眼轴长度检测。采用ＳＹＢＲＧｒｅｅｎＩ实时荧光定量ＰＣＲ检测豚鼠脉络膜中Ｔ-ＰＡｍＲＮＡ的表达变化,ＥＬＩＳＡ测定脉络膜中Ｔ-ＰＡ蛋白水平的表达变化。结果　屈光度及眼轴长度:入组前豚鼠屈光状态为远视状态,各组间屈光度及眼轴长度比较差异均无统计学意义（均为Ｐ＞０．０５）。随着周龄的增加,３周龄、５周龄、７周龄、９周龄远视屈光度逐渐降低,眼轴长度逐渐增加,差异均有统计学意义（均为Ｐ＜０．０１）,各组屈光度及眼轴长度与入组前差异均有统计学意义（均为Ｐ＜０．０５）。ＰＣＲ及ＥＬＩＳＡ检测结果显示:脉络膜中Ｔ-ＰＡｍＲ-ＮＡ及蛋白水平各组总体比较差异均有统计学意义（Ｐ＜０．０１、Ｐ＜０．０５）,且均在豚鼠发育到５周龄时表达量增加,与３周龄、７周龄、９周龄相比差异均有统计学意义（均为Ｐ＜０．０５）,３周龄分别与７周龄、９周龄相比差异均无统计学意义（均为Ｐ＞０．０５）,７周龄Ｔ-ＰＡ的ｍＲＮＡ及蛋白表达量与９周龄相比差异均无统计学意义（均为Ｐ＞０．０５）。结论　在豚鼠眼球发育和正视化过程中,脉络膜Ｔ-ＰＡ在５周龄时表达量显著增加,但在之后发育过程中表达量逐渐下降,９周龄时回落至３周龄时的水平。     

BAMBI过表达抑制缺氧诱导的恒河猴视网膜血管内皮细胞增殖和迁移

目的　探讨过表达激活素膜结合抑制剂（ｂｍｐａｎｄａｃｔｉｖｉｎｍｅｍｂｒａｎｅ-ｂｏｕｎｄｉｎｈｉｂｉｔｏｒ,ＢＡＭＢＩ）对缺氧诱导的恒河猴视网膜血管内皮细胞（ＲＦ／６Ａ）增殖和迁移的影响。方法　将ＲＦ／６Ａ细胞分为四组:正常对照组、缺氧组、缺氧＋ｐＦＬＡＧ组和缺氧＋ＢＡＭＢＩ组。Ｗｅｓｔｅｒｎｂｌｏｔ检测各组细胞中ＢＡＭＢＩ的表达,倒置显微镜观察各组细胞形态和密度,ＣＣＫ-８法和流式细胞仪分别检测各组细胞的增殖和周期情况,Ｔｒａｎｓｗｅｌｌ检测细胞的迁移,Ｗｅｓｔｅｒｎｂｌｏｔ检测转化生长因子β１（ｔｒａｎｓｆｏｒｍｉｎｇｇｒｏｗｔｈｆａｃｔｏｒ-β１,ＴＧＦ-β１）和血管内皮生长因子（ｖａｓｃｕｌａｒｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ,ＶＥＧＦ）的表达。结果　与对照组相比,缺氧组细胞数目明显增多,增殖增加,培养１２０ｈ后,对照组细胞增殖倍数为５．００±０．２８,缺氧组为７．６４±０．３２（Ｐ＜０．００１）;缺氧组Ｓ期进程显著加快,占（１０．４４±２．６１）％,对照组Ｓ期占（２０．７９±２．２３）％（Ｐ＜０．０５）;细胞迁移增加,缺氧组细胞数目为３３．８０±４．２０,对照组为８．３５±２．５０（Ｐ＜０．０５）,ＴＧＦ-β１和ＶＥＧＦ的表达明显增加（Ｐ＜０．０５）。缺氧＋ＢＡＭＢＩ组:缺氧处理的细胞转染ｐＦＬＡＧ-ＢＡＭ-ＢＩ后,与缺氧组相比,ＢＡＭＢＩ蛋白表达显著上调,细胞数目明显减少,增殖显著降低,培养１２０ｈ后,增殖倍数为５．５３±０．２７（Ｐ＜０．００１）,细胞Ｓ期受到阻滞,占（１８．７５±２．９２）％,迁移显著下降,数目为１３．００±２．８０（Ｐ＜０．０５）,ＴＧＦ-β１和ＶＥＧＦ的表达明显下调（Ｐ＜０．０５）。结论　过表达ＢＡＭＢＩ可抑制缺氧诱导的ＲＦ／６Ａ细胞的增殖和迁移,进而有望抑制视网膜血管新生。     

Mean Platelet Volume is Associated with Diabetic Macular Edema in Patients with Type-2 Diabetes Mellitus

Aim: To evaluate the effect of the platelet indices on the stage of diabetic retinopathy (DR) and diabetic macular edema (DME). Methods: In this retrospective study, the mean platelet valume (MPV), Plateletcrit (PCT), platelet (PLT), and platelet distribution width (PDW) of 199 diabetic patients and 76 healthy subjects were enrolled. The participants were divided into four groups. The first group was healthy control; the second group consisted of diabetic patients without DR; the third group was nonproliferative DR (NPDR); and the fourth group was proliferative DR (PDR). Results: Significant differences were found only in MPV and PCT values between patients with diabetes and healthy participants (8.6±0.96 fL vs 8.32±0.9 fL, P=0.011, 0.216± 0.58 vs 0.202±0.52, P=0.038). Comparing the groups, a statistically significant difference in MPV values was found between groups 4 and 1 (8.91±.7 fL vs 8.32±0.9 fL P=0.001) and between groups 4 and 3 (8.91±.7 fL vs 8.42±0.9 fL P=0.014). The MPV values of patients with DME were significantly higher than those of diabetic patients without DME (8.87±0.80 fL vs 8.45±0.97 fL). Conclusion: High MPV values may be an important risk factor for the development of PDR and DME in patients with diabetic retinopathy.     

不同OCT分型的糖尿病性黄斑水肿与血小板参数的关系

目的研究不同OCT分型的糖尿病性黄斑水肿(diabetic macular edema,DME)与血小板参数的关系。方法回顾性研究。118例(118眼)糖尿病视网膜病变(diabetic retinopathy,DR)患者中,DME组88眼,未合并DME(Non-DME)组30眼,根据DME的OCT形态分为弥漫性视网膜增厚型(diffuse retinal thickening,DRT)27眼、黄斑囊样水肿(cystoid macular edema,CME)29眼、神经上皮层脱离型(neurosensory retinal detachment,NSD)32眼,对不同组别间患者血小板计数(platelet count,PLT)、平均血小板体积(mean platelet volume,MPV)、血小板平均分布宽度(platelet distribution width,PDW)和血小板压积(plateletcrit,PCT)进行比较,并分析DR分期与DME的OCT分型间的关系。结果DRT在轻度和中度非增生型DR中的占比为50.0%,而NSD在重度非增生型DR及增生型DR患眼中的占比较高,为84.5%。DME组患者的MPV和PDW均明显高于Non-DME组(均为P<0.05),NSD患者的MPV和PDW均明显高于DRT和CME患者(均为P<0.05)。结论不同DME分型的患者MPV、PDW有差异,血小板与NSD的发生、发展可能相关。     

2型糖尿病患者平均血小板体积与糖尿病黄斑水肿的关系

目的　探讨2型糖尿病患者平均血小板体积（mean platelet volume,MPV）与糖尿病性黄斑水肿（diabetic macular edema,DME）的关系。方法　本研究共有四组患者,分别是健康对照组（组1,n=40例）、有糖尿病无糖尿病视网膜病变（diabetic retinopathy,DR）组（组2,n=40例）、有DR无DME组（组3,n=40例）和DR伴DME组（组4,n=40例）,采集患者一般信息,散瞳眼底彩照和OCT检查,检测外周血血小板4参数:血小板计数（platelet count,PLT）、MPV、血小板平均分布宽度（platelet distribution width,PDW）和血小板压积（plateletcrit,PCT）。比较4组患者PLT、MPV、PDW和PCT。结果　四组间MPV和PDW差异均有统计学意义（均为P<0.05）,而PLT和PCT差异均无统计学意义（均为P>0.05）。组间比较MPV和PDW显示,组3［（11.07±1.06）fL、（13.57±2.25）fL］和组4［（11.27±0.85）fL、（13.89±1.76）fL］分别均高于组1［（10.41±0.63）fL、（11.93±1.22）fL］和组2［（10.38±0.51）fL、（12.33±1.28）fL］（均为P<0.05）。组4的MPV和PDW均高于组3,但差异均无统计学意义（P=0.254、0.388）。男性患者MPV组间比较显示,组2（10.29±0.58）fL、组3（10.67±1.08）fL和组4（11.42±0.90）fL逐渐增大（P<0.05）,而组1（10.27±0.55）fL和组2间差异无统计学意义（P>0.05）。女性患者MPV组间比较显示,组3（11.37±0.69）fL和组4（11.13±0.79）fL分别均高于组1（10.55±0.70）fL和组2（10.42±0.49）fL（均为P<0.05）,组3和组4间差异无统计学意义（P>0.05）。结论　MPV升高可能是2型糖尿病DR患者发生DME的一个重要危险因素,监测血小板参数有助于DR病情监控。     

血小板分布宽度及纤维蛋白原与DR严重程度的关系

目的：明确血小板分布宽度( platelet distribution width, PDW)及纤维蛋白原( fibrinogen,FIB)与糖尿病视网膜病变( diabetic retinopathy,DR)严重程度之间的关系。
　　方法：选取2012-06/2014-05在我院眼科及内分泌科住院的DR患者99例(非增殖期48例,增殖期51例),同时选取50例无DR糖尿病患者和50例无糖尿病健康人进行对照。采集基本资料,抽空腹血行PDW、FIB、血小板计数、空腹血糖及糖化血红蛋白(HbA1c)等检查。
　　结果：糖尿病各组人群 PDW 水平显著高于健康对照组(16.6%±1.2%)(P<0.05),且随DR病变分级的增加, PDW 水平显著增加,分别为17.6%±1.8%,19.1%±2.1%,20%±1.9%,差异有统计学意义(均为P<0.05)。糖尿病各组FIB水平也显著高于健康对照组( P<0.05)。多因素Logistic回归分析显示,在校正年龄、性别、病程及糖化血红蛋白等因素后,随着PDW及FIB水平升高,非增殖期(OR：1.464,PDW)(OR：2.199,FIB)和增殖期DR (OR：1.652,PDW)(OR：2.691,FIB)的患病风险显著增加(均为P<0.05)。
　　结论：PDW和FIB水平随DR严重程度升高而增加,非增殖期和增殖期DR患病风险随PDW及FIB水平升高而增加。     

Relationship between mean platelet volume and retinopathy in patients with type 2 diabetes mellitus

Objectives

To evaluate the effect of mean platelet volume (MPV) on diabetic retinopathy in patients with type 2 diabetes mellitus.

Materials and methods

In this study, ocular findings and MPV values were retrospectively reviewed in 192 patients with type 2 diabetes mellitus. The patients were classified into four groups according to ocular findings, as follows: group 1, diabetic patients without diabetic retinopathy (n?=?70); group 2, diabetic patients with non-proliferative diabetic retinopathy (n?=?64); group 3, diabetic patients with proliferative diabetic retinopathy (n?=?58); and group 4, healthy controls (n?=?100).

Results

A significant difference was found in MPV values between groups 2 and 4 (P?=?0.001), between groups 3 and 4 (P?=?0.001), and between groups 1 and 4 (P?=?0.004). No significant difference was found in MPV values between groups 1 and 2 (P?=?0.241) and between groups 2 and 3 (P?=?0.460); whereas there was a statistically significant difference between groups 1 and 3 (P?=?0.015). The three diabetic groups (groups 1, 2, and 3) were compared with each other. While there was a statistically significant difference between groups 1 and 3 (P?=?0.015), there was no significance between groups 2 and 3 (P?=?0.46), and between group 1 and 2 (P?=?0.241). Logistic regression analysis found a 1.40-fold increase in the risk of retinopathy development (OR: 1.404; P?=?0.002) and a 1.46-fold increase in the risk of proliferative diabetic retinopathy (OR: 1.466; P?=?0.002) as the MPV value increased.

Conclusions

In diabetic patients, the risk of retinopathy development increases with higher MPV values.     

Risk factors associated with retinal neovasculari-zation of diabetic retinopathy in type 2 diabetes mellitus

AIM: To evaluate the risk factors associated with retinal neovascularization of diabetic retinopathy in northern Chinese Han patients with type 2 diabetes mellitus (T2DM). METHODS: The clinical characteristics of 200 patients with proliferative diabetic retinopathy (PDR) and 100 age-matched healthy individuals were compared. The univariate and multivariate logistic regression analysis were performed in the patients with PDR. RESULTS: Fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), blood urea nitrogen (BUN), uric acid (UA), white blood cell count (WBC), absolute neutrophil count, hematocrit (HCT) and mean platelet volume (MPV) and mean platelet volume (MPV) were all significantly higher in patients with PDR than in the control group (P<0.05). The univariate and multivariate logistic regression analysis showed that risk factors independently associated with retinal neovascularization of DR were duration of diabetes mellitus (OR=1.112; P =0.000), BUN (OR=1.277; P=0.000), smoking (OR=3.967; P=0.000) and MPV(OR=2.472; P=0.000). On the other hand, panretinal photocoagulation was associated with reduced risk of retinal neovascularization (OR=0.983; P=0.000). CONCLUSION: Preventing and controlling T2DM in terms of risk factors, including duration of diabetes, BUN, smoking and MPV, might offer novel approaches to prevent or delay the onset of retinal neovascularization in patients with PDR.     

Diabetic retinopathy and HLA antigens in type 2 diabetes mellitus

PURPOSE: Diabetic retinopathy is the most common complication of diabetes mellitus. No single predisposing factor has been identified, and genetic factors may play a role in the development of severe retinopathy. In this study, we investigated the association between diabetic retinopathy and HLA antigens in type 2 diabetes mellitus. METHODS: This study was conducted at the retina unit of the Department of Ophthalmology of Ondokuz Mayis University between October 1999 and March 2000, and included 46 diabetics with non-proliferative retinopathy and 30 with proliferative retinopathy, with 30 nondiabetic controls. HLA class I (A, B, C) antigens were studied by Terasaki's microlymphocytotoxicity test and HLA class II (DR, DQ) typing was carried out using a polymerase chain reaction-sequence specific primer. RESULTS: HLA-DR4 and DQ8 frequencies were higherin patients with non-proliferative retinopathy than those with proliferative retinopathy, and HLA-DR7 frequency was higher in patients with proliferative retinopathy than non-proliferative cases (p<0.05). No significant differences in HLA antigens were found between patient groups and controls. CONCLUSIONS: The differences in HLA antigen frequencies between patients with and without proliferative retinopathy suggest a genetic contribution to diabetic retinopathy.     

Inhibition of TGF-β2-induced migration and epithelial-mesenchymal transition in ARPE-19 by sulforaphane

AIM: To investigate the effects of sulforaphane (SFN) on transforming growth factor (TGF)-β2 stimulated migration and epithelial-mesenchymal transition (EMT) in ARPE-19 cells. METHODS: ARPE-19 cells were cultured in the presence or absence of SFN or TGF-β2. SFN toxicity was assessed by performing a lactate dehydrogenase assay (LDH) and 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assays, and cell migration was evaluated by Transwell migration assay. Actin stress fiber formation in ARPE-19 cells was determined using immunofluorescence analysis. Immunoblotting analysis was used to determine fibronectin and α-smooth muscle actin expressions along with the degree of Smad and Akt phosphorylation. RESULTS: SFN inhibited ARPE-19 migration. Additionally, SFN attenuated TGF-β2-induced appearance of actin stress fibers as well as fibronectin and α-smooth muscle actin expressions in these cells. SFN also hindered the TGF-β2-stimulated phosphorylation of Smad2, Smad3, and Akt. SFN showed no cytotoxicity towards ARPE-19 cells. CONCLUSION: SFN inhibits TGF-β2-stimulated migration and EMT in ARPE-19 cells, probably by preventing the establishment of actin stress fibers and Akt and Smad2/3 signaling.     

Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai

AIM: To predict postoperative intraocular lens (IOL) position using the Sirius anterior segment analysis system and investigate the effect of Lens position and IOL type on postoperative refraction. METHODS: A total of 97 patients (102 eyes) were enrolled in the final analysis. An anterior segment biometry measurement was performed preoperatively with Sirius and Lenstar. The results of predicted lens position (PLP) and IOL power were automatically calculated by the software used by the instruments. Effective lens position (ELP) was measured manually using Sirius 3mo postoperatively. A Pearson’s correlation analysis and linear regression analysis were used to determine the correlation of lens position to other parameters. RESULTS: PLP and ELP were positively correlated to axial length (AL; r=0.42, P<0.0001 and r=0.49, P<0.0001, respectively). There was a weak correlation between the peLP (ELP-PLP) and the prediction error of spherical refraction (peSR; r=0.34, P<0.0001). The peLP of the Softec HD IOL differed statistically from those of both the TECNIS ZCB00 and Sensor AR40E IOLs. Multiple linear regression was used to obtain the prediction formula: ELP=0.66+0.63 [aqueous depth (AQD)+0.6LT] (r=0.61, P<0.0001), and ELP was found to have the strongest correlation with a new variable (AQD+0.6 LT). CONCLUSION: The Sirius anterior segment analysis system is helpful to predict ELP, which reduces postoperative refraction error.     

血小板活化因子及血小板四参数在糖尿病视网膜病变中的变化及临床意义

目的 探讨血小板活化因子和血小板四参数在糖尿病视网膜病变(diabetic retinopathy,DR)中的关系.方法 选取2015年1月至2015年12月于我院眼科就诊的糖尿病患者80例(160眼),行常规眼科检查、眼底荧光素血管造影检查等,依据国际临床DR分级标准,将患者分为3组:糖尿病无视网膜病变(单纯糖尿病)组20例,非增生型糖尿病视网膜病变(non-prolif-erative diabetic retinopathy,NPDR)组20例,增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组20例;同期门诊体检的健康人20人为正常对照组.测定血小板活化因子CD62p、CD63,血小板四参数:血小板计数(platelet count,PLT)、平均血小板体积(mean platelet volume,MPV)、血小板压积(plateletcrit,PCT)、血小板平均分布宽度(platelet distribution width,PDW),探讨血小板活化因子及血小板四参数在DR中的变化及其临床意义.结果 CD62p、CD63、MVP随着病情的进展逐渐增高,而PLT逐渐降低,各组间差异有统计学意义(P＜0.05).与正常对照组相比,其他各组的CD62p、CD63和MVP增高,PLT降低,差异均有统计学意义(均为P＜0.05).与单纯糖尿病组相比,NPDR组和PDR组的CD62p、CD63和MVP增高,PLT降低,差异均有统计学意义(均为P＜0.05).与NPDR组相比,PDR组的CD62p、CD63和MVP增高,PLT降低,差异均有统计学意义(均为P＜0.05).对照组、单纯糖尿病组、NPDR组和PDR组的PDW逐渐增高,与正常对照组或单纯糖尿病组相比,NPDR组和PDR组的PDW增大,差异均有统计学意义(均为P＜0.05).PCT组间比较差异无统计学意义(P＞0.05).结论 血小板活化因子CD62p、CD63和血小板四参数在DR各期表现有所差异,血小板活化因子在DR的发生、发展过程中有重要的作用,对血小板活化因子及血小板四参数的检测有助于疾病的监控.